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Endovascular Repair of Thoracic Aortic Aneurysms
You have been diagnosed with a thoracic aortic aneurysm. It is common for these
aneurysms to have no symptoms, therefore you may feel well. These aneurysms can
be a very serious health risk depending on the size and location within the thoracic
aorta. An aneurysm has the potential to either rupture (burst) or dissect (layers of
the aortic wall separate), which can be threatening. However when detected in a
timely manner, aneurysms can be treated effectively.
Given the anatomy and configuration of your aneurysm and your overall health, an
endovascular repair of your thoracic aortic aneurysm is the best treatment for you.
Since this is a complex procedure, we’ve provided this guide to help you understand
what you can expect with your procedure and recovery. If you have questions about
the information you read or about your condition, please talk with your physician.
A thoracic aortic aneurysm is a bulging in the portion of the aorta located in the
chest that is caused by the pressure of blood pumping through areas where the wall
of the aorta has weakened. Thoracic aortic aneurysms can develop in any segment
of the thoracic aorta, including your aortic root, ascending aorta, aortic arch and
descending thoracic aorta (Figure 1). The descending thoracic aorta is the most
common location for a thoracic aortic aneurysm to form, followed by the ascending
aorta and lastly the aortic arch.
right subclavian
right common carotid
left common carotid
right subclavian
right common carotid
left common carotid
brachiocephalic trunk
left subclavian
brachiocephalic trunk
left subclavian
right subclavian
right common carotid
brachiocephalic trunk
left common carotid
left subclavian
While aneurysms can occur due to several different causes, the most common cause
is atherosclerosis (plaque build-up within the arterial wall). Over time, this plaque
can cause the walls of the aorta to become stiff and weak, creating the potential for
an aneurysm to form.
Some factors that increase your risk for atherosclerosis are:
 High blood pressure
 High cholesterol
 Being overweight
 A family history of cardiovascular disease
Other factors that increase your risk for developing a thoracic aortic aneurysm are:
 Age (greater than 55)
 Gender (occurrence in males is more prevalent than females)
 Family history of aneurysms (please ask your physician about screening
of family members)
 Genetic disorders that affect connective tissue, such as Marfan syndrome, Ehlers-Danlos syndrome, Loeys-Dietz syndrome
 Infections, such as syphilis or tuberculosis
It is common for thoracic aortic aneurysms to form without symptoms. Over half of
patients do not experience symptoms. For those who do experience symptoms,
the following can be warning signs of a thoracic aortic aneurysm:
 Chest or back pain
 Pain in the jaw, neck and/or upper back
 Coughing or shortness of breath
 Hoarseness caused by pressure on the vocal cords
 Difficulty swallowing caused by pressure on the esophagus
Treatment options for thoracic aortic aneurysms vary and include medical
management (monitoring the aneurysm while controlling blood pressure), open
surgery and catheter-based endovascular repair.
Endovascular repair
Your health care provider has
recommended an endovascular repair.
This is a minimally invasive procedure
and when performed to repair a thoracic
aortic aneurysm, it is known as a TEVAR, or
Thoracic Endovascular Aortic Repair. For
this procedure, small incisions are made
in your groin. Long, thin tubes known as
catheters are guided through using an X-ray
to obtain real-time images and a stent graft
is inserted where the aneurysm is located
(Figure 2).
The stent graft is positioned such that it realigns the weakened blood vessel and
prevents the aneurysm from rupturing. Over time, your aorta will shrink back to its
normal size.
Before the procedure
Here are some tips and information that will help your procedure be as successful
as possible:
 The evening before your surgery, you may eat a normal dinner. However, you cannot eat or drink anything, including water, gum or hard candy, beginning at midnight prior to your operation.
 Bring a list of your current medications that includes the names, dosages and how often you take them.
Talk to your physician about possible drug interactions. If you are taking
anticoagulant (blood-thinning) medication, such as Warfarin, Coumadin or
antiplatelet medication such as Plavix, or Aspirin, you may be asked to stop taking them because they make it more difficult for your blood to clot.
 Talk to your health care provider about which medications you should stop and for how long. You should also ask your health care provider which medications you should still take on the day of your surgery.
 You will be given a special soap to wash with the day before your surgery, which decreases bacteria on your skin and may help reduce the risk of infection after your procedure.
 For the comfort and safety of all patients, UF Health requests that you do not
bring jewelry, valuables, electric appliances (hair dryer, shaver, heating pads,
etc.), food or medications with you on the day of your procedure.
 Shortly before your scheduled time of surgery, you will be taken to the pre-op
care unit. An intravenous, or IV, line may be started before the procedure to provide fluid and any pre-op medications you have not yet received.
Before going to the operating room, remove all jewelry, including rings. You may wear your glasses/contacts, dentures and/or hearing aids until you go to surgery so you can communicate with members of the team in the preparation area. Prior to going to the operating room, your pre-op nurse will give these items to your family until you need them during recovery.
General anesthesia is used so you will be asleep during the procedure. To prevent
spinal cord ischemia (paralysis) by decreasing spinal cord pressure, a spinal drain
may be placed in your back if indicated.
Incisions will be created in both your right and left groin. Using wires and catheters,
the aorta will be accessed through these small incisions. X-rays will be taken using
a special contrast dye that helps visualize blood vessels (Figure 3). Under this
direct visualization, a stent graft is guided over the wires into the aorta. Then it is
positioned and deployed to cover and exclude the aortic aneurysm.
After the procedure
You will be taken to the intensive care unit, or ICU. Once you are medically ready,
typically after one or two days, you will move to a medical-surgical unit. You are
asked to lay flat in bed until the spinal drain has been discontinued, usually 24 hours
after your procedure. When you are tolerating a diet and able to walk, you may leave
the hospital two to five days after the endovascular repair.
There are risks associated with every procedure. Those specific to this
operation include, but are not limited to:
 Weakness or complete paralysis of legs
 Transient issues with the kidneys secondary to the dye (contrast)
 Endoleak (poor seal/apposition of the graft to the arterial wall)
 Infection of the groin incision
 Bleeding
Post-operative care
For two weeks after the endovascular repair, you should not lift anything that
weighs more than five to 10 pounds. If you are taking narcotic medications, do not
drive or operate heavy machinery as these medications can impair judgment. You
may shower and let soap and water run over your incisions, but must pat them dry
afterwards. You may return to work when you are cleared by your doctor.
Check your incision daily for signs of infection (redness, increased tenderness,
warmth or swelling). If you develop sudden shortness of breath or chest pain, or if
you notice changes in color, sensation or strength in your legs, please seek medical
attention immediately.
Over time, stent grafts may have problems such as kinking, migration or leakage
and you may or may not experience symptoms. Therefore, you will need lifelong
routine surveillance with CT scans. Most problems seen after repair can be managed
with endovascular techniques.
At the time of discharge, you will be provided an appointment at one month and
six months from the date of repair with a repeat CT scan to evaluate the stent graft
and remodeling of the aorta around the graft. After that, follow-up is typically done
yearly. It is crucial that you are compliant with the follow-up plan provided to you to
ensure the most successful outcome after your procedure.
We look forward to caring for you.
Our top priority is to make your procedure with us successful
and as easy and comfortable as possible.
If you have any comments, questions or concerns about
your experience at the UF Health Aorta Center, please don’t
hesitate to contact our program manager Julie Sablik, MBA,
at 352.594.6239 or [email protected] Your feedback is
very valuable in helping us to continually enhance the
patient experience.
Appointments at the UF Health Aorta Center are held at UF
Health Surgical Specialists, located on the first floor of
UF Health Shands Hospital.
1600 SW Archer Road • Gainesville, FL 32608
Fax: 352.627.4173